Recovering from our Cultural Addictions

St. Stephen’s Episcopal Church

Friday, April 30th – Sunday, May 2nd
Name:______________________________________________________________________________
__

Address:____________________________________________________________________________
__

Phone Number:_____________________________
Email:__________________________________

Parish:______________________________________________________________________________
_

Housing Options:

_____ Yes, I would like housing and prefer a single room. ($240.00)

_____ Yes, I would like housing and I would like a roommate. ($170.00)
I would like my roommate to be_________________________________

_____ I do not need housing but I look forward to attending the Retreat ($100.00)

I have the following food and/or dietary restrictions:

______ I am a vegetarian

______ I need a gluten free meal

Other (please specify):

____________________________________________________________________________________

____________________________________________________________________________________

Please send your registration form and a deposit (half of retreat fee) to the following
address:

The Berkshire Servant Leadership Center

c/o St. Stephen’s Episcopal Church
67 East St.
Pittsfield, MA 01201
Upon receipt of your registration we will send you a welcome letter.
We look forward to meeting you upon your arrival on April 30th.